Community care experiments for frail older people : two care management programmes evaluated

The inadequacy of community-based services for frail older people in the 1970s pointed to the need for providing co-ordinated care responsive to multiple needs. The fully evaluated Kent Community Care Project (KCCP), a care management experiment which pioneered this new approach, successfully maintained users for longer at home with enhanced quality of life at no additional cost.

While the KCCP benefited from intensive support from the evaluation team, there was a need to investigate whether schemes set up in other areas could be successful when the promotion of good practice was limited to that provided by the agency. The schemes evaluated in this study were early replications of the KCCP in two contrasting parts of Kent. County-wide mechanisms were set up to encourage good practice, such as regular meetings of field staff and managers on policy and practice issues, a working group to develop procedures, peer review and monitoring and feedback. A full cost-effectiveness analysis was undertaken on each of the two schemes using a quasi-experimental design with before/after evaluation interviews on matched experimental and control groups over a one year period which was costed.

Both schemes successfully maintained users at home for significantly longer, and achieved significant improvements in quality of life, quality of care and health status, though less striking than in the KCCP, again at no additional cost. However, they differed from the KCCP in causing a considerable shift in expenditure from health services to social services, with a consequent striking reduction in hospital bed-blocking as well as care home use. Cost-outcomes analyses suggested that budget caps were too generous for resources to be deployed most efficiently.

Because this study took place during the early 1980s, it has been treated largely in its historical context. Nevertheless, the investigation also suggests some important ways in which the current practice of post-reform care management might be improved.